Routine Intraoperative Transesophageal Echocardiography (TEE) on Surgical Management in Paediatric Cardiac Surgery: Impact and Cost-effective analysis.

Transesophageal echocardiography (TEE) preoperative in paediatric cardiac surgery has many applications. Over the past few decades, perioperative echocardiography has solidified its role as a critical diagnostic and perioperative management tool for patients with congenital heart disease (CHD). Perioperative TEE has proved to be invaluable in confirming the preoperative diagnosis, formulating the surgical plan, evaluating immediate operative results, identifying patients with residual defects, and guiding surgical revisions. Residual lesion or defect after cardiac surgery is known and this not only hampers the fast-tracking of the patient but also utilises huge resources of the institute while the patient stays on a ventilator and in ICU.

After standard non-invasive monitoring, anaesthesia will be induced. TEE probe will be inserted after induction of the child and standard images will be recorded. Examinations will be performed using GE Vivid T8 echocardiography platform. Relevant images will be stored for future review and comparison. Heart rate (HR), systolic, diastolic, mean arterial blood pressure (MAP), and oxygen saturation will be invasively monitored throughout the surgery. All surgical procedures will be performed by experienced surgeons using standardized techniques. Cardiopulmonary bypass (CPB) and anaesthesia management will be performed according to our standard operating procedures. Any change or modification in the surgical management will be noted before the start of the surgery and after coming off bypass to look for adequacy of surgical correction, cardiac function, and any significant residual lesion and the findings will be conveyed to the operating surgeon. Any significant residual lesion, requiring surgical revision or a second CPB will be noted as an impact of TEE on surgical decision-making. TEE examination will also be repeated after the second CPB. The patients will be observed and evaluated for residual lesions and complications during the ICU stay. Apart from the demographic profile of the patient collected operative data will include aortic cross-clamping (CCT), and cardiopulmonary bypass (CPB). Any adverse events will be recorded. ICU measurements, postop ICU stay, Duration of MV, and any TEE-related adverse event. The cost benefit analysis will be done from health care providers prespective and incremental cost effectiveness ratio would be calculated.